ACCUTANE 20MG CAPSULE (100 (10X10) BLPK) (NDC: 00004016949)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
FreedomBlue PPO HD Rx (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
SecurityBlue Basic (HMO)
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $1,284.23 |
Browse Plan Formulary |
FreedomBlue PPO Select (PPO)
|
$23.70 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,252.35 |
Browse Plan Formulary |
SecurityBlue Standard (HMO)
|
$28.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PPO Classic (PPO)
|
$38.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,252.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityBlue Deluxe (HMO)
|
$46.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,252.35 |
Browse Plan Formulary |
FreedomBlue PPO Platinum (PPO)
|
$83.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,252.35 |
Browse Plan Formulary |